The Anatomy of the Human Peritoneum and Abdominal Cavity: Considered from the Standpoint of Development and Comparative AnatomyHuntington, George S. (George Sumner)
Science
The Anatomy of the Human Peritoneum and Abdominal Cavity: Considered from the Standpoint of Development and Comparative Anatomy
Huntington, George S. (George Sumner)
Abdomen; Peritoneum
Having once passed this narrow space the finger will be in the Spigelian
recess and can palpate its boundaries. Further progress cephalad and to
the right is barred by the diaphragmatic adhesions of the liver just
detailed. But in the direction downward behind the lesser omentum and
along the dorsal surface of the stomach, as well as to the left toward
the spleen the excursion is limited only by the length of the examining
finger.
After opening the abdominal cavity of the human adult, elevating the
liver and depressing the stomach, the hepatic attachment of the lesser
omentum can be traced as already described. It will then be observed
that the gastric attachment of the membrane lies in one plane following
the lesser curvature while the hepatic attachment forms a broken line,
with the angle situated at the left extremity of the transverse fissure.
The vertical segment of the hepatic attachment, occupying the fissure
for the ductus venosus, turns at this angle into the transverse segment
which follows the transverse fissure to its right extremity where the
two layers pass into each other around the right free omental margin
(hepato-duodenal ligament). Consequently we overlook, in an abdominal
cavity thus exposed, the entire caudal surface of the liver, including
the caudal surfaces of right, left, and quadrate lobes. The junction of
right and caudate lobes can be seen between vena cava and right edge of
the omentum, or rather, it can be felt at this point. But the Spigelian
lobe, turning its surface dorsad against the parietal peritoneum
covering the diaphragm, forms part of the "posterior" liver surface and
is not visible, although--as just stated, it can be palpated by passing
the finger through the foramen of Winslow. The Spigelian lobe cannot be
overlooked in its entire extent until the liver is removed from the body
and regarded from behind. The caudal edge (continuation of its right
angle into the caudate lobe and papillary tubercle) can be seen by
tearing through the layers of the lesser omentum and lifting the liver
up forcibly (Fig. 286).
=Caudal Boundary of Foramen of Winslow.=--We have above referred to the
fact that the finger introduced through the foramen of Winslow meets in
this canal with resistance if an attempt is made to pass downwards.
After passing this constricting point the free excursion into the
Spigelian recess and behind the omentum and stomach and toward the
spleen can be performed.
In considering the elements which produce this narrowing of the
communication between the two peritoneal sacs at the foramen of Winslow
we have to deal with two factors, one primary and constant, the other
secondary and inconstant.
1. The first of these is afforded by the arrangement of the arterial
vessel supplying the liver. The hepatic artery is a branch of the coeliac
axis, furnishing arterial blood to the liver tissues and supplying, in
addition, branches to the stomach, duodenum and pancreas.
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